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A realidade do mercado médico brasileiro The reality of brazilian medical market
Jurandir Marcondes Ribas Filho,Osvaldo Malafaia,Nicolau Gregori Czeczko
Revista do Colégio Brasileiro de Cirurgi?es , 2009, DOI: 10.1590/s0100-69912009000300001
Abstract:
Peritonite infecciosa com quantitativos e qualitativos bacterianos conhecidos: estudo experimental em ratos
Guilgen, Gilton ?ngelo;Czesko, Nicolau Gregori;Malafaia, Osvaldo;Sim?es, Jo?o Carlos;
Revista do Colégio Brasileiro de Cirurgi?es , 1998, DOI: 10.1590/S0100-69911998000100010
Abstract: this study reveals development of difuse peritonitis model in rats with a known bacterial concentration. we analised 150 rats, adults, mate, wistar race with medium weight of 150 grams. solutions of escherichia coli and bacteroides fragilis in diferent concentrations were percutaneous inoculated into the peritoneal cavity in the following proportion: 1 ml of each suspension to each 100 grams of the total weight of the rato the animals were allocated in five groups of thirty rats. on - group i (control) a solution of sodium cloride 0.9%. on the following groups the proportions were as follows: group ii - 10(9); group iii - 10(8); group 1v -10(7) and group v - 10(6). after a rat death, a necropsy was performed in order to evaluate macroscopic effects on peritoneal cavity as well collect samples of secretions for culture. the survival rats ofeach group were subdivided with no choice in two subgroups. the animals for subgroup a were sacrificed 24 hours after inoculation and the ones of subgroup b, 120 hours after inoculation. we observed that the rats of group 1 did not acquire peritonitis. on group ii and iii, 100% of subgroup a and 95.03% of subgroup b, developed acute peritonitis. on group ii only 4.17% developed peritonitis and died 72 hours and on group v neither peritonitis or death developed. the animals which died on group ii and iii on an average of 96.67% showed macroscopic alterations with difused peritoneum exudate, adherences and no abscesses. the animals which developed peritonitis exhibited bilateral pleural effusion. on animals of group ii and iii which died, also were found the presence of eschirichia coli and bacteroides fragilis responsible for peritonitis and pleural effusion. this model shows that the animal which received the highest bacterial concentrations showed loss of weight, clinical alterations of sepsis, acute peritonitis with pleural effusion and premature death.
Avalia??o da espessura do complexo médio-intimal da artéria carótida como marcador de aterogênese acelerada secundária a dano vascular na esclerose sistêmica progressiva
Macedo, Rodrigo;Andretta, Marianne;Albers, Carolina;Skare, Thelma;Ribas-Filho, Jurandir Marcondes;Czeczko, Nicolau Gregori;
Revista do Colégio Brasileiro de Cirurgi?es , 2012, DOI: 10.1590/S0100-69912012000100004
Abstract: objective: to evaluate the intima-media thickness of the common carotid artery in patients with and without scleroderma; to verify a possible association with disease severity; to assess the relationship of intima-media thickness with known cardiovascular risk factors. methods: in a case-control study, were selected 30 patients with scleroderma and 30 without the disease and matched according to age, sex and cardiovascular risk factors such as hypertension, diabetes mellitus and hypercholesterolemia. the age ranged from 17 to 79 years (mean 49). all patients underwent carotid artery evaluation by high-resolution vascular doppler in order to measure the intima-medial thickness of the carotid 2 cm from the bifurcation. in all the analysis was considered the greatest value of intima-media thickness in right and left carotid arteries. results:the sample consisted of 30 patients, being 29 (96.67%) women and one man (3.3%). in this sample, 11/30 (36.67%) had high blood pressure, 5/30 (16.67%) had diabetes mellitus, 6/30 (20%) had dyslipidemia and 2/30 (6.67%) were smokers. comparing the measure of the increased risk (maximum intima-media thickness between the left and right side), was obtained an average of 0.77 mm for group scleroderma and a value of 0.70 mm for the control group (p = 0.21). in assessing the association between disease severity and carotid intima-media thickness, was found no significant association (p= 0.925). conclusion: was found a slight increase in intima-medial thickness of common carotid artery in patients with scleroderma but without statistical significance. regarding the severity of the disease and intima-medial thickness of common carotid artery, there was no significant difference.
Integra o: palavra para quem quiser viver o futuro! Integration: word to live the future!
Nelson Adami Andreollo,Ivan Cecconello,Cláudio José Caldas Bresciani,Nicolau Gregori Czezcko
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2010, DOI: 10.1590/s0102-67202010000100002
Abstract:
Estudo comparativo das extens es das les es causadas por duas e quatro passadas de laser Erbium em ratos Wistar com 0% de sobreposi o dos spots
Noronha Lúcia de,Martins Vanessa D. M.,Tafarel Jean Rodrigo,Czeczko Nicolau Gregori
Acta Cirurgica Brasileira , 2001,
Abstract: Lasers de CO2 tem sido apresentados com a finalidade de rejuvenecer a face através do resurfacing. Embora cada sistema de laser tenha o mesmo princípio básico, há significativa diferen a entre os lasers que pode resultar em varia es no efeito tecidual clínico e histológico. O laser Erbium:YAG que tem como característica o comprimento de onda com 10 vezes mais afinidade pela água que o laser de CO2. O propósito deste estudo experimental foi comparar as altera es morfométricas encontradas em 2 e 4 passadas com laser Erbium:YAG com sobreposi o de 0% dos spots. Foi avaliada a homogeneidade da abla oem comprimento e usou-se a pele do dorso de 3 ratos in vivo. Foi selecionada uma área de pele controle de cada rato. Finalmente, num período máximo de 3 horas, a pele foi ressecada e encaminhada à histopatologia para as avalia es propostas. Como resultados com 4 passadas houve mais homogeneidade da extens o da abla o do que em 2 passadas. Conclui-se que a extens o e homogeneidade de abla o foi maior com 4 passadas. A utiliza o de 0% de sobreposi o dos spots n o garante homogeneidade de abla o.
Procalcitonina como biomarcador de prognóstico da sepse grave e choque séptico Procalcitonin as a prognostic biomarker of severe sepsis and septic shock
José Raimundo Araujo de Azevedo,Orlando Jorge Martins Torres,Nicolau Gregori Czeczko,Felipe Francisco Tuon
Revista do Colégio Brasileiro de Cirurgi?es , 2012,
Abstract: OBJETIVO: Avaliar a tendência da concentra o plasmática e do clearance de procalcitonina (PCT-c) como biomarcadores de prognóstico de pacientes com sepse grave e choque séptico, comparado a um outro marcador precoce de prognóstico representado pelo número de critérios de SIRS no momento do diagnóstico da sepse. MéTODOS: Estudo de coorte prospectivo observacional onde foram incluídos pacientes com sepse grave e choque séptico. A concentra o sérica de procalcitonina foi determinada no momento do diagnóstico da sepse e após 24 e 48 horas. Foram coletados dados demográficos, escore APACHE IV, escore SOFA na chegada, número de critérios de SIRS no momento do diagnóstico, sitio da infec o e resultados microbiológicos. RESULTADOS: Vinte e oito pacientes foram incluídos, 19 clínicos e nove cirúrgicos. Em 13 (46,4%) a fonte da sepse foi pulmonar, em sete abdominal (25,0%), em cinco urinária (17,9%) e de partes moles em três casos (10,7%). Quinze pacientes tinham sepse grave e 13 choque séptico. A mortalidade global foi cinco pacientes (17,9%), três deles com choque séptico. Vinte e oito determina es de PCT foram realizadas no momento do diagnóstico da sepse, 27 após 24 horas e 26 após 48 horas. A concentra o inicial n o se mostrou expressivamente diferente entre os grupos sobreviventes e n o sobreviventes, mas as diferen as entre os dois grupos após 24 e 48 horas alcan aram significancia estatística expressiva. N o se observou diferen a em rela o ao número de critérios de SIRS. O clearance de procalcitonina de 24 horas mostrou-se expressivamente mais elevado no grupo de sobreviventes (-3,0 versus -300,0, p=0,028). Embora o clearance de procalcitonina de 48 horas tenha mostrado resultado mais elevado no grupo de sobreviventes comparado aos n o sobreviventes, a diferen a n o alcan ou significancia estatística. CONCLUS O: Concentra es persistentemente elevadas de procalcitonina no plasma, assim como, redu o do PCT-c 24 horas, associaram-se à eleva o expressiva da mortalidade de pacientes com sepse grave e choque séptico. OBJECTIVE: To evaluate the tendency of the plasma concentration and clearance of procalcitonin (PCT-c) as biomarkers of prognosis of patients with severe sepsis and septic shock, compared to another early prognosis marker, the number of SIRS criteria at sepsis diagnosis. METHODS: We conducted a prospective, observational, cohort study, with patients with severe sepsis and septic shock. The serum procalcitonin was determined at diagnosis of sepsis and after 24 and 48 hours. Demographic data, APACHE IV, SOFA score on arrival, number of SIRS c
Estudo comparativo das extens?es das les?es causadas por duas e quatro passadas de laser Erbium em ratos Wistar com 0% de sobreposi??o dos spots
Noronha, Lúcia de;Martins, Vanessa D. M.;Tafarel, Jean Rodrigo;Czeczko, Nicolau Gregori;Fran?a, Ant?nio Luiz Francalacci;
Acta Cirurgica Brasileira , 2001, DOI: 10.1590/S0102-86502001000200007
Abstract: co2 lasers has been presented with the purpose of rejuvenating the face by means of resurfacing. though each laser systems has the same base principle, there is a significant difference among lasers which could result in variations in the clinical and histological effects of the tissue. the erbium:yag laser has the characteristic of having the wavelength with 10 times more affinity for water than the co2 laser. the purpose of this experimental study was to compare the morphometric alterations found in 2 and 4 erbium:yag laser passes with 0% overlap of spots. it was evaluated the homogeneity of ablation in length and was used the dorsal skin of 3 living mice. it was selected a control area in each mouse. finally, in the maximum period of three hours, the skin was resected and sent to histopathology for evaluations proposed. as a result there was more homogeneity in the length of the ablation with 4 passes than with 2 passes. the conclusions of the experiment indicated that the length and homogeneity of the ablation were larger with 4 passes. the use of 0% overlap of spots does not guarantee homogeneity in ablation.
Comparative study between polypropylene and polypropylene/poliglecaprone meshes used in the correction of abdominal wall defect in rats
Utrabo, Carlos Alberto Lima;Czeczko, Nicolau Gregori;Busato, Cesar Roberto;Montemor-Netto, Mario Rodrigues;Malafaia, Osvaldo;Dietz, Ulrich Andreas;
Acta Cirurgica Brasileira , 2012, DOI: 10.1590/S0102-86502012000400004
Abstract: purpose: to evaluate the healing process of a defect in the ventral abdominal wall of rats, comparing the polypropylene and polypropylene/poliglecaprone meshes on the 30th and 60th postoperative day. methods: thirty two wistar rats were submitted to a ventral abdominal wall defect, with integrity of the parietal peritoneum. in the repair, were used polypropylene (group a) and polypropylene/poliglecaprone (group b) meshes. the groups were subdivided into four subgroups of eight animals euthanized on the 30th (a30 and b30) and 60th postoperative day (a60 and b60). fragments of the abdominal wall of the animals were submitted to macroscopic, tensiometric and histological evaluations. results: the tensiometry on subgroup a30 showed a mean average break point of 0.78 mpa and in a60, 0.66 mpa. in subgroup b30 it was 0.84 mpa and in b60, 1.27 mpa. the score of the inflammatory process showed subacute phase on a30 and b30 sub-groups and chronic inflammatory process in subgroups a30 and 60b. conclusions: the tensile strength was higher on the wall repaired by polypropylene/poliglecaprone mesh in the 60th post-operative day. histology showed higher concentration of fibrosis on the surface of the polypropylene mesh with a tendency to encapsulation. in polypropylene/poliglecaprone subgroups the histology showed higher concentration of fibrosis on the surface of mesh filaments.
Estudo comparativo entre a colangiopancreatografia por ressonancia magnética e a colangiopancreatografia endoscópica no diagnóstico das obstru??es biliopancreáticas
PISANI, Julio Cesar;BACELAR, Anna;MALAFAIA, Osvaldo;RIBAS-FILHO, Jurandir Marcondes;CZEZCKO, Nicolau Gregori;NASSIF, Paulo Afonso Nunes;
Arquivos de Gastroenterologia , 2001, DOI: 10.1590/S0004-28032001000300002
Abstract: background ? the endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography were methods used for diagnosis of the diseases in the biliary and pancreatic ducts. aim - compare the diagnostic concordance among, analyzing sensitivity, specificity, positive predictive value, negative predictive value and accuracy. patients/methods - there were 41 patients in the studied group, divided in two groups: i ? without biliary or pancreatic tract obstruction, and ii ? with obstruction. group ii was further divided in a ? obstruction due to lithiasis, and b ? due to other causes. results - concordance between the two methods was found in 67% in group i and 82% in group ii. sensitivity of endoscopic retrograde cholangiopancreatography was 94% and magnetic resonance cholangiopancreatography was 89%. specificity of endoscopic retrograde cholangiopancreatography was 100% and magnetic resonance cholangiopancreatography was 67%. magnetic resonance cholangiopancreatography positive predictive value was 93%, the negative predictive value was 50% and the accuracy was 85%. conclusion - both methods showed the same sensitivity.
Avalia??o imunoistoquímica dos receptores de estrogênio e progesterona no cancer de mama, pré e pós-quimioterapia neoadjuvante
Pachnicki, Jan Pawel Andrade;Czeczko, Nicolau Gregori;Tuon, Filipe;Cavalcanti, Tereza Santos;Malafaia, Andressa Bressan;Tuleski, Ana Maria;
Revista do Colégio Brasileiro de Cirurgi?es , 2012, DOI: 10.1590/S0100-69912012000200002
Abstract: objective: to evaluate the immunoexpression of estrogen and progesterone receptors in biopsies and surgical specimens of patients with breast cancer before and after neoadjuvant chemotherapy and to correlate their changes with the pattern of response to chemotherapy and diagnosis of menopause. methods: we selected 47 patients with histological diagnosis of locally advanced primary breast carcinoma. for each patient there were two blocks: the biopsy specimen and surgical resection one. from these blocks hormone receptor expression was assessed by immunohistochemistry using the technique of streptoavidin-biotin-immunoperoxidase and anti-er and anti-pr primary antibodies. the statistical analysis used the student's t test and the nonparametric fisher's exact test, with significance level of 5%. results: of the 47 patients, 30 showed positive immunostaining for hormone receptors. there was significant reduction in the levels of both estrogen and progesterone receptors and in their immunoreactivity. in 53.3% we observed changes in levels of estrogen receptor expression, 56.6% in the progesterone receptor, 26.6% in the immunoexpression of estrogen receptor immunoreactivity and 33.3% in the immunoreactivity of the progesterone receptor. there was no statistical correlation between the influence of the response to chemotherapy and the diagnosis of menopause in women with variation in the expression of hormone receptors. conclusion: neoadjuvant chemotherapy has significantly altered hormone receptor immunoreactivity in patients in the sample, reducing its positivity in tumor cells.
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